CMS’ Chris Klomp, Stephanie Carlton talk affordability, prior authorization, drug pricing

CMS Deputy Administrator and Director of Medicare Chris Klomp and Deputy Administrator and Chief of Staff Stephanie Carlton talked with AHA Board Chair Marc Boom, M.D., president and CEO, Houston Methodist, about CMS’ policies in the past year and looking ahead on affordability, commercial health plan accountability, drug prices and the Rural Health Transformation Fund.

“The mission [for CMS] is about unlocking every American’s full potential by making it easy to be healthy,” said Carlton. She detailed the four pillars upon which current CMS policy is built: fighting fraud, health care affordability, Make America Healthy Again initiatives, and streamlining the agency through technology, including artificial intelligence.

Klomp spoke on how CMS is working with commercial insurance companies to reform prior authorization policies. “I am utterly convinced that prior authorization represents the greatest breakdown in trust between providers and payors in modern-day health insurance,” he said, noting that last year the administration and some insurance providers reached a voluntary agreement to improve the prior authorization system. He also cited a 2025 agreement between the administration and many major drug companies that pledged to adopt most-favored-nation pricing.

Carlton mentioned the importance of the $50 billion Rural Health Transformation Fund in enabling rural hospitals to continue serving their communities through technology and innovation. Now that the first payments have been distributed, Carlton described CMS’ role as supporting states in using the money well, because “if you live in a rural area, your health outcomes should be just as good as if you lived in an urban area.”